To the Editor Wilkinson et al1 reported the need for adolescents to continue or to initiate contraception during the coronavirus disease 2019 pandemic. In this context, they advise using telehealth to prescribe contraception without physical examination and based on the medical history of young people, mainly young women.
Nota original: JAMA Pediatrics Souhail Alouini, MD, PhD1; Goda Venslauskaite, MPh2 https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2020.5080?guestAccessKey=666dbce6-66bf-4def-8030-03a93bf058bf&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamapediatrics&utm_content=olf&utm_term=1130
However, it is not in accordance with gynecological practices to prescribe estrogen-progestin pills without a physical breast examination. Indeed, estrogen-progestin pills are contraindicated in cases of breast tumors, and breast cancer is the most common cancer among adolescents.2
Furthermore, the authors recommend the use of the levonorgestrel intrauterine device in some cases, which is also contraindicated in case of breast cancer. Its use increases the risk of breast cancer.3 In these cases, information on these breast cancer risks must be provided. We are very surprised to read that the authors recommend the use of ullipristal acetate as emergency contraception when this drug has been withdrawn from the European market since March 2020 because of a new case of severe hepatitis in a woman, requiring liver transplant.4
The authors state that contraception is safer than pregnancy. We do not think that contraception is comparable with pregnancy, even if we agree with the authors that it is important that adolescents (aged 11 to 19 years in the World Health Organization definition) should be protected against unwanted pregnancies by accessing to an efficient contraception. What concerns teenage pregnancy, we showed that teenagers are more likely to have a preterm delivery but less likely to have gestational diabetes than older women. However, the rate of vaginal deliveries is similar between teenagers and older women, but adolescents have more vaginal tears.5
Finally, in the pandemic context of coronavirus disease 2019, some forms of contraception can be prescribed by telehealth for a short time. However, physical examination of patients remains essential before prescribing contraception to exclude and screen serious pathologies.